CN101267774A - A surgical drill, a set of surgical drills, a system for cutting bone and a method for removing bone - Google Patents

A surgical drill, a set of surgical drills, a system for cutting bone and a method for removing bone Download PDF

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Publication number
CN101267774A
CN101267774A CNA2006800349444A CN200680034944A CN101267774A CN 101267774 A CN101267774 A CN 101267774A CN A2006800349444 A CNA2006800349444 A CN A2006800349444A CN 200680034944 A CN200680034944 A CN 200680034944A CN 101267774 A CN101267774 A CN 101267774A
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drill
millimeters
cutting
surgical drill
surgical
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CN101267774B (en
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霍格兰德·托马斯
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Antje Sikoma Hoagland
Yap Jonas Hoagland
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1613—Component parts
    • A61B17/1615—Drill bits, i.e. rotating tools extending from a handpiece to contact the worked material
    • A61B17/1617—Drill bits, i.e. rotating tools extending from a handpiece to contact the worked material with mobile or detachable parts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1613—Component parts
    • A61B17/1615—Drill bits, i.e. rotating tools extending from a handpiece to contact the worked material
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1613—Component parts
    • A61B17/1633—Sleeves, i.e. non-rotating parts surrounding the bit shaft, e.g. the sleeve forming a single unit with the bit shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1671—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1695—Trepans or craniotomes, i.e. specially adapted for drilling thin bones such as the skull
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1697—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans specially adapted for wire insertion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/164—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans intramedullary
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1796—Guides or aligning means for drills, mills, pins or wires for holes for sutures or flexible wires
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation

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  • Surgical Instruments (AREA)

Abstract

The present invention relates to a surgical drill including a drill member having a cutting section for cutting bone, the cutting section being situated at a distal end of the drill member. The drill member also comprises a non-cutting protection tip for protecting nerves, tissue or dura from being cut. The non-cutting protection tip is situated distally of the cutting section.

Description

Surgical drill, surgical drill group, the method that is used for the system of cutting bone and removes skeleton
Technical field
The present invention relates to a kind of as claim 1 surgical drill as described in the preamble, surgical drill group, the method that is used for the system of cutting bone and removes skeleton.
In field of spinal surgery, need to remove the part and the little joint capsule in little joint by adopting the back side or posterolateral operation, intravertebral structure is come out.Removing of bony segment structure enforcement to vertebra is the spinal canal that is filled with nervous tissue for approaching.Organizational structure in intraspinal nervous tissue is very fragile, has tree-like construction, and promptly the middle body of spinal canal is filled with rectangular (cerebral dura mater) be made up of nerve fiber.Be full of the rectangular of nerve from this, the level of nerve root between vertebrae occurs left and branch to the right, and nerve root is left spinal canal by passage, the hole of both sides.
In human body, comprise the dural sack of nerve fiber and branch can be compressed in spinal canal by following state on pathology level thereof, be in the hole (passage) perhaps:
1. intervertebral disc is partly given prominence to or is extruded
2. little joint hypertrophy
3. little joint capsule hypertrophy
4. the synovial cyst in little joint
Intraspinal tumor or
6. disc collapses may cause dwindling of hole.
The compression of other nerve fiber of branch in this dural sack and the dural sack causes patient's pain, numbness even paralysis.Most common complication is an intervertebral disk hernia.
Will be near spinal canal, so that treatment or remove pathological tissues, the bone portion around need removing.By removing little joint capsule of part and the little joint of part skeleton, can producing diameter is 6 to 11 millimeters opening, can insert a work intubate like this.By this work intubate, the surgeon can operate the pathological interspinal tissue, for instance, can use the standard apparatus, removes this tissue such as grasper, curet, reamer, laser etc.By such work intubate, spatial cleaning between also can coiling where necessary can insertion dish interbody spacer device or cage shape thing.When the work intubate existed, the operation of removing intraspinal pathologic structure can be further by means of endoscope.
This operation is carried out under the control of two-dimentional x-ray image booster usually.
Removing skeletal structure with near spinal canal, is a very accurate and responsive program.It must be avoided injury or cut off any neural bar (nerve sack) (cerebral dura mater) or any nerve root branch, because this injury is breakneck, patient possibly can't recover.
Open the standardization program of spinal canal and use surgical drill or milling cutter to produce an opening always, to open spinal canal at little joint capsule and/or little joint.These drill bits all must be advanced and very meticulous, not injure even to cut off intraspinal organizational structure.
U.S. Pat 5931841 has disclosed and has been used for orthopedic borer-reamer combination.U.S. Pat 6443956 has disclosed vertebra drill bit and insert.
Summary of the invention
Therefore, the purpose of this invention is to provide a kind of surgical drill and a kind of system that is used to remove skeleton,, increase reliability by protection vertebra inner tissue.
This purpose realizes that by the described surgical drill of claim 1 comprising the drill member with the cutting part that is used for cutting bone, described cutting part is in the far-end of drill member.Described drill member comprises a non-cutting protection end, and described non-cutting protection end neuroprotective, tissue and cerebral dura mater are not cut off, and described non-cutting protection end is positioned at the far-end of the cutting part of drill member.Because nerve, tissue and cerebral dura mater have been protected in the existence of non-cutting protection end in cutting process.Because protection portion does not cut, only cause moving of each soft tissue with intraspinal neuromechanism, tissue or dural any contact.Owing to non-cutting protection end is arranged, can get rid of reliably and cut off or the interior fragile soft tissue of injured spinal canal.
Term among the present invention " far " and " closely " are often referred to the relation of they and operating theater instruments, " far " refer to operating theater instruments when being used away from a surgical end, and " closely " refers to operating theater instruments close surgical end when being used.In other words, far-end is that operating theater instruments at first is inserted into the intravital end of patient, and the end at operation position normally, and near-end is in surgical hands.
In a preferred embodiment of surgical drill, described cutting part has first overall diameter, and described non-cutting protection end has second overall diameter less than described first overall diameter of described cutting part.In other words, the diameter of described non-cutting protection end is less than the diameter of described cutting part.In a preferred embodiment, the difference of diameter is 1 millimeter to 2 millimeters.The advantage of this preferred embodiment is, other passages that described non-cutting protection end can be inserted into guiding channel or got out by previous drilling equipment before using present surgical drill.Therefore, non-cutting protection end can also be as a guiding device not just in order to protect intraspinal fragile soft tissue, and the guiding surgical drill is along the direction cutting bone of the guiding channel that had before got out.This advantage of bringing is to adopt the cutting process of this surgical drill to carry out easily, and this is because the surgeon can be absorbed in the pressure of drill bit and the speed of boring fully, does not need to concentrate on centring, adjusting angle and aims at drill bit.In addition, as described in following surgical drill group and surgical drill system, use such drill bit to be convenient to expand the drilled tunnel that has existed, can reach required diameter through a plurality of boring steps.
In a preferred embodiment, the described non-cutting protection end of described surgical drill comprises that at least one columnar portion and at least one are positioned at the conus portion of described columnar portion far-end.In further preferred embodiment, described non-cutting protection end comprises that at least one is positioned at the spherical portion of conus portion far-end.Described columnar portion helps the good centering of the axle of described surgical drill, and described conus portion helps described non-cutting protection end is inserted the passage that has bored in the skeletal structure.This embodiment can make the surgeon and insert described surgical drill and centering reliably with respect to the passage that has existed.The described spherical portion of described non-cutting protection end guarantees that nerve, tissue and/or cerebral dura mater are protected in cutting process.
Described non-cutting protection end is preferably dull face.Described non-cutting protects end at least one preferably to be arranged through polishing and/or slick surface portion, especially through the surface portion of machine glazed finish and/or the surface portion of process electropolishing.In a preferred embodiment, described non-cutting protection end and/or drill member have slick outermost layer and/or coating, especially level and smooth coating and/or the low-friction coating, particularly polytetrafluorethylecoatings coatings of quality.Select not sharp, smooth surface, selectively coat the non-adhesive material,, thereby can make tissue obtain better protection because intraspinal delicate tissue can not come to harm or stretch because of the described protection portion bonding with drill bit.
For the advantage that makes described non-cutting protection end is more obvious, preferred, described protection portion is at least 5 millimeters in the length of distal direction (axial direction of drilling equipment), is preferably between 5 to 15 millimeters, is preferably 5 millimeters, 10 millimeters or 15 millimeters.These different pipes that are of a size of in the skeleton that passes previous cutting provide reliable guiding, but then, do not extend too far in spinal canal when boring finishes, and cutting part only enters the short distance of spinal canal.The length selection of described non-cutting protection end depends on the size and the structure of the anatomic construction, particularly spinal canal of actual patient.
Preferably, described non-cutting protection end is circular, and may have, for example semicircular cross section, half elliptic cross section or cross section similarly circle, smooth shape.
In a preferred embodiment, for reliable cutting is provided, described cutting part has and the contiguous cut end of described non-cutting protection end.In other words, the longitudinal axis of drill member is vertical with the cut end towards cutting part.
In further preferred embodiment, described drill bit comprises a sleeve, and described telescopic interior diameter is chosen as drill member can easily be inserted and rotate.Protective tissue when tissue when described sleeve is used in described drill bit inserts body around the protection and described drill bit start.
In a preferred embodiment, described sleeve has female thread at its near-end, and described drill member has external screw thread at its near-end, and therefore described drill member can be advanced with respect to described sleeve by the relative rotation of drill member.By this setting, can accurately control described drill member with respect to described telescopic feeding rate.When described cutting part not from cutting the drill bit screw thread but during a kind of milling cutter, this is especially useful.
In a preferred embodiment, the described drill member of described surgical drill has the coaxial guiding channel that extends vertically in described drill member, so guide wire can be inserted in the guiding channel.Preferably, the near-end of described guiding channel from the remote extension of described drill member to described drill member.This guide wire as following the explanation, is to be used for guiding described drill member to enter into needed position in the patient body along described guide wire, helps to improve precision especially and reduces the time that operation continues.
The described cutting part of described drill member for example can be stiletto, trepan, milling cutter, reamer or trepan.Described cutting part also can have the drill bit screw thread.
In a preferred embodiment, described surgical drill has handle, detachable handle and/or is connected to the adapter of power auger at the near-end of described drill member, thereby allows the surgeon to select appropriate drive mode according to different situations.
Purpose of the present invention also realizes by the described surgical drill group of claim 18.The surgical drill group comprises aforesaid one first surgical drill and one second surgical drill at least.In addition, the overall diameter of the cutting part of described first surgical drill is equal to or greater than the overall diameter of the non-cutting protection end of described second surgical drill.As top explanation, the drill bit group that the configuration of such two drill bits forms can be used for successfully expanding and have guiding channel in the skeleton.The non-cutting protection end of described first surgical drill in the described surgical drill group enters the guiding channel that gets out in advance in the skeleton.Drive described first surgical drill then, produce the passage have with the corresponding interior diameter of overall diameter of the cutting part of described first surgical drill.The described passage that described first surgical drill produces is centered at described guiding channel.After described first surgical drill is finished boring and is got out passage with the corresponding diameter of overall diameter of the cutting part of described first surgical drill; insert described second surgical drill, its non-cutting protection is held insert the passage that the described first operation bit drills goes out.Next, drive the described passage that described second surgical drill is gone out by the described first operation bit drills with expansion.Has the corresponding interior diameter of overall diameter with the cutting part of described second surgical drill by the described second described passage that goes out of operation bit drills.Passage in described second skeleton that goes out of operation bit drills is centered at the passage that gone out by the described first operation bit drills.Can change the quantity of required different drill bits according to this method, to the last the overall diameter of a surgical drill cutting part with carry out skeleton in be that required passage interior diameter is corresponding in the skeleton of spinal canal operation.
In a preferred embodiment, described surgical drill group comprises a plurality of surgical drills, and the cutting diameter of its cutting part is respectively 3 millimeters, 4 millimeters, 5 millimeters, 6 millimeters, 7 millimeters, 8 millimeters, 9 millimeters, 10 millimeters, 11 millimeters and 12 millimeters.Diameter also can be preferably 3.5 millimeters, 4.5 millimeters, 5.5 millimeters, 6.5 millimeters, 7.5 millimeters, 8.5 millimeters, 9.5 millimeters, 10.5 millimeters, 11.5 millimeters and 12.5 millimeters.In further preferred embodiment; the cutting part diameter of described surgical drill group drill bit is 4 millimeters, 6 millimeters, 8 millimeters and 10 millimeters, and the diameter of the corresponding described non-cutting protection end of described surgical drill group is respectively 2 millimeters, 4 millimeters, 6 millimeters and 8 millimeters.The diameter of the described non-cutting protection end of described surgical drill is so selected, and makes them can be inserted in the smaller relatively hole that drill bit comes outbreak out of described surgical drill group.
In a preferred embodiment, the axial length of the described non-cutting protection end of all surgical drills all equates.
Purpose of the present invention also realizes by the system of the described cutting bone of claim 29.Except surgical drill, this system also comprises a work intubate of inserting health.Described work intubate is in order to insert operating theater instruments after the passage appearance of suitable diameter.
In a preferred embodiment, described system also comprises pin, and particularly 18 gage needle are used for the location and pass systemic first passage, and, also comprise the guide wire that inserts this passage.Use this pin can be so that a passage that passes the skeleton surrounding tissue is provided, the direction of using guide wire can accurately harmonize the guiding channel or first drilled tunnel.
In another preferred embodiment, described system comprises an expanding bar, is used to expand intravital passage.Because this additional expanding bar, intravital passage can be expanded, and finally makes the described sleeve of described first surgical drill to be inserted into.
In addition, purpose of the present invention also realizes by the described method that removes skeleton of claim 34.According to the method; removing of skeleton may further comprise the steps: the guiding channel that will have initial diameter is introduced skeleton; cutting diameter is stretched into guiding channel greater than the surgical drill of initial diameter; surgical drill has the non-cutting protection end that diameter is equal to or less than the guiding channel initial diameter at its far-end; before boring, described non-cutting protection end inserts guiding channel.Described method comprises that further the surgical drill that a series of cutting diameter is increased gradually passes the passage that previous surgical drill produces; the diameter of wherein said non-cutting protection end is equal to or less than the cutting diameter of previous surgical drill, and described non-cutting protection end is inserted in the passage that the cutting part by previous surgical drill produces.
In the conversion of preferred this method, guiding channel passes the place of safety of each skeleton, and is especially tangent with skeleton pipe (as spinal canal).
In the conversion of this method, by make drill bit pass joint capsule or loose skeleton enter neural bar (cerebral dura mater) side and produce guiding channel in the place of safety of the spinal canal at branch and excitor nerve root center.
In the 3rd conversion of this method, drill bit enters the tissue of pathological changes, for example intervertebral disk hernia part, little joint or skeleton capsule hypertrophy, synovial cyst or tumor.
In further conversion, surgical drill passes guiding channel, and surgical drill has a non-cutting protection end, is 5 millimeters to 15 millimeters to the distance of distal-most end, and wherein the diameter held than described non-cutting protection of the overall diameter of cutting part is big 1 millimeter to 2 millimeters.
In the conversion of this method, guide wire extend into guiding channel, and the apparatus of Shi Yonging is guided by guide wire subsequently.Adopt this guide wire, advantage is guide wire is inserted in the axially extended guiding channel of surgical drill.
In the conversion of this method, before the guiding channel in skeleton produces, adopt the pin of opening passage, preferably 18 gage needle are passed skeleton tissue on every side.
In a conversion, guide wire extend in the passage of being opened by described pin.In addition, expanding bar can extend into and expand described passage in the passage of being opened by described pin.Further, stretch into passage with cover, for the work of first surgical drill provides service aisle through expansion.
Description of drawings
Fig. 1 is the vertical view of groove and surgical drill;
Fig. 2 is the sleeve of 18 gage needle, expanding bar, Yamshidi pin and the vertical view of drill bit;
Fig. 3 is the cross sectional representation of intervertebral operative site;
The cross sectional representation of the operative site of Fig. 3 when Fig. 4 is cover and surgical drill insertion skeletal structure;
The cross sectional representation of the operative site of Fig. 3 and Fig. 4 when Fig. 5 is the guiding of drill bit employing guide wire;
Fig. 6 a and 6b hold the sketch map that gets on the skeleton by non-cutting protection;
The cross sectional representation of Fig. 7 operative site of Fig. 3 to Fig. 5 that is the work intubate when organizing;
Fig. 8 a is the view of two kinds of different non-cutting protection ends of drill member with 8b;
Fig. 9 is the sketch map of the near-end of sleeve and surgical drill, and it has the threaded portion that matches each other;
Figure 10 a and 10b are the schematic side elevations of the surgical drill of further embodiment;
Figure 11 a and 11b are the schematic side elevations of the surgical drill of the further embodiment relevant with 10b with Figure 10 a;
Figure 12 is the schematic plan of the handle of surgical drill among Figure 10 a, 10b, 11a and the 11b.
The specific embodiment
Fig. 1 shows surgical drill 1 of the present invention, comprising the drill member 10 with cutting part 11 and non-cutting protection end 12.The overall diameter d ' of described cutting part 11 is corresponding with the diameter of actual cutting in skeleton.In addition, cutting part 11 has the bit face structure 110 that is used for cutting bone.Cutting part 11 is positioned at the far-end of drill member 10.The diameter of non-cutting protection end 12 is d.The diameter d of non-cutting protection end 12 is less than the diameter d of cutting part 11 '.Specifically, poor the d '-d=1mm of the diameter of the diameter of the cutting part 11 of embodiment and non-cutting protection end 12 among the figure.All figure do not draw according to size.
Described non-cutting protection end 12 be smooth dull face, and described dull face has face coat, not with vertebra in tissue bond.The face coat of described non-cutting protection end 12 is made of the coating of low friction, the coating that for example polytetrafluorethylecoatings coatings, and/or quality is level and smooth, and/or the face coat of similar characteristics is arranged.
Described drill member 10 has handle 15 at its near-end.
Described drill member 10 has sleeve 2, and sleeve 2 covers described drill member 10 when described drill member 10 is inserted health.Described sleeve 2 has sleeve passage 20, and the interior diameter of described sleeve passage 20 is d ".The interior diameter d of described sleeve passage 20 " the described drill member 10 that is chosen for described surgical drill 1 can be inserted into, and advance by telescopic sleeve passage 20.
In a preferred embodiment of the invention, the size of sleeve 2 can make described drill member 10 in sleeve 2 inward turnings then sleeve 2 is moved, but on the other hand, and the overall diameter of preferred sleeve 2 is satisfying under the situation of above-mentioned condition as far as possible for a short time.In other words, the wall thickness of sleeve 2 is preferably thinner.This sleeve preferably adopts a kind of like this material manufacture, allows telescopic wall thickness thinner, and for example rustless steel or other have the material of like attribute.
In another preferred embodiment of the present invention, the interior diameter of the drill member 10 that the overall diameter correspondence of sleeve 2 is inserted subsequently makes the overall diameter of sleeve 2 expand sleeve tissue on every side, so that the sleeve and/or the drill bit of back can be inserted in the body.
The face coat of described sleeve 2 makes jacket casing 2 insert bodily tissue easily.This face coat comprises coating and/or the low-friction coating that quality is level and smooth, for example polytetrafluorethylecoatings coatings.
In Fig. 2, other elements in the system that surgical drill 1 among Fig. 1 and sleeve 2 constituted have further been comprised.
The hollow needle 3 of the specification 18 shown in Fig. 2 is to be used for opening in skeletal structure first passage, and the surgical drill 1 among Fig. 1 will work at this passage.Hollow needle 3 has a trocar (trocar) (not shown) in its hole, this trocar can insert body internal clock note guide opening (pilotnotch) by organizing at pin 3, makes can be positioned at suitable position when boring sky.After guide opening entered skeleton, the trocar was recalled from pin 3, and pin 3 also keeps motionless, thin guide wire 4 to be inserted in the hole of pin 3, made a position in guide opening of guide wire 4 contact skeleton.
Expanding bar 5 shown in Fig. 2 comprises that one is passed expanding bar, axially extended guiding channel 51 from the near-end to the far-end.Guide wire 4 is inserted in the guiding channel 51 of expanding bar 5, makes expanding bar 5 be directed into guide opening in skeleton and the skeleton along guide wire 4.Described expanding bar 5 has expansion end 50 at its far-end, and maximum gauge is d ' ", preferably be equal to or slightly less than the interior diameter of the Yamshidi sleeve 7 of introduction in the back.Tissue around the expanding bar expansion skeleton.
Yamshidi sleeve 7 is parts of Yamshidi pin.Described Yamshidi sleeve 7 is placed on the position of expanding bar 5, with guiding Yamshidi sleeve 7 to the tram.Subsequently, expanding bar is recalled from Yamshidi sleeve 7, and the Yamshidi trocar (not shown) of Yamshidi pin is inserted in the Yamshidi sleeve 7, in the position of guide opening, with the bullport in the angle generation skeletal structure that the surgeon was determined.Be preferably in and carry out aforesaid operations under the two-dimentional X-ray.Subsequently, the Yamshidi trocar is recalled from Yamshidi sleeve 7, and traditional drill bit 8 is inserted in the Yamshidi sleeve 7, gets out guiding channel in the skeleton in the position of bullport and angle.After guiding channel bored, traditional drill bit took off from Yamshidi sleeve 7, again Yamshidi sleeve 7 was put in expanding bar 5, left health then.The sleeve 2 of surgical drill 1 shown in Figure 1 is placed in the position of expanding bar 5, and expanding bar 5 is recalled from sleeve 2 subsequently.Then, the drill member 10 of surgical drill 1 enters sleeve 2, and its non-cutting protection end is inserted into the guiding channel that pierces skeleton, and drill member work then is expanded to guiding channel the overall diameter of the cutting part 11 of surgical drill 1.
So far, Fig. 2 shows the apparatus at several the positions that are used to make arrangements for surgery, so that surgical drill shown in Figure 1 can enter.
Fig. 3 shows the cross section of spinal structure 6.Specifically, Fig. 3 shows the lateral muscular tissue 60 of intervertebral, intervertebral disc anchor ring 61, spinal canal 62, kernel 63, a part of intervertebral disc 64, little joint 65, cerebral dura mater 66, little joint capsule 67 and nerve root 68 that give prominence to/skids off.Therefrom as can be seen, outstanding intervertebral disc 64 is oppressed cerebral dura mater 66 and a part of nerve rooies 68.This causes pain to patient.
Therefore, task will remove this exactly and give prominence to, and removes any tissue that does not belong to spinal canal 62.Outstanding in order to remove this, need in skeletal structure, open passage, particularly enter spinal canal 62 by little joint 65 and little joint capsule 67.
The process stage of opening this passage as shown in Figure 4.Fig. 4 shows the spine structure among Fig. 3, is inserted into the lateral muscular tissue 60 of intervertebral by first sleeve, 2 cingens first surgical drills 1, drills through the first in little joint 65 along pre-drilled guiding channel 650.
Second boring step is by first surgical drill 1 is fetched from first sleeve, and second sleeve with diameter bigger than first sleeve of second surgical drill is placed on the first telescopic position, fetches first sleeve from second sleeve.Next, second surgical drill is inserted second sleeve, the passage that its non-cutting protection end insertion is gone out by the first operation bit drills.The 3rd to n boring step also is like this.
As can be seen from Figure 5, after through n boring step, last surgical drill 1 ' is inserted into operative site along guide wire 4 '.Guide wire 4 ' is inserted in the passage 651 after previous surgical drill takes out from its sleeve.Follow previous sleeve and also be removed, only the guide wire 4 ' of remaining thicker (about 1-2 millimeter) is stayed body interior.Last surgical drill 1 ' has a through hole 13, described through hole along axis direction from drill member 10 near-end to remote extension and be placed on the position of guide wire 4 '.In a preferred embodiment, last surgical drill 1 ' does not comprise sleeve, so that the overall diameter of last boring step is as much as possible little, so that low as much as possible to the pressure of surrounding tissue.
In the stage as shown in Figure 5, surgical drill 1 has almost passed little joint 65, and next bore portion attempts to pass little joint capsule 67.In this case, non-cutting protection end 12 has entered spinal canal 62 and has touched outstanding intervertebral disc 64.But because non-cutting protection end 12 is not sharp and have slick surface, 64 quilts of outstanding intervertebral disc push away this zone.Even it is a pathological tissues, can directly not remove this tissue yet.Because pathological tissues can controllably be removed in subsequent step, doing has like this increased reliability.In addition, be under the situation of boring direction at cerebral dura mater 66 or nerve root 68, non-cutting protection end 12 pushes away away this tissue lightly in cutting process.In other words, because non-cutting protection end 12 at first enters spinal canal, it can make all delicate tissue and the neural sharp-pointed cutting edge that leaves cutting part 11 in the spinal canal 66.
In addition, as can be seen from Figure 6, non-cutting protection end 12 helps guiding drill member 10 to pass existing guiding channel 650 in the little joint 65.Apparent from Fig. 6 a, non-cutting protection 12 is inserted into the guiding channel 650 in the little joint 65, and drill member 10 and cutting part 11 are positioned at the central authorities of guiding channel 650 thus.From Fig. 6 b, as can be seen, bore too small joint 65, form corresponding expanding channel 651 with the overall diameter d ' of cutting part 11 when drill member 10.Expanding channel 651 is coaxial with the guiding channel 650 of previous cutting.Adopt this mode, passage 651 can be expanded, until reaching required diameter.The delicate tissue that non-cutting protection end 12 is used to protect in the spinal canal 62.
Fig. 7 shows the operative site identical with Fig. 3 to Fig. 5.Use work intubate 9 to pass tissue in the drawings and insert skeleton, thereby the surgeon can insert operating theater instruments work intubate 9 and comes intraspinal tissue is operated.
Fig. 8 shows 10 two kinds of different non-cutting protection ends of drill member.Cutting part 11 among the mode a has the surface texture 111 of similar drill bit screw thread.Cutting part 11 among the mode b is different, and it has the surface texture 112 of similar reamer.The length l of non-cutting protection end is between 5 millimeters and 15 millimeters.
Fig. 9 shows the near-end of the assembly of surgical drill 1 and sleeve 2.The drill member 10 of surgical drill 1 has external screw thread 122, and is corresponding with telescopic female thread 222.This configuration makes the surgeon surgical drill 1 to be screwed in the sleeve 2 with controllable mode.When cutting part is a milling cutter, there is not female thread especially useful when being screwed into surgical drill by rotation.
Use operating theater instruments mentioned above, can form the method that intraspinal various pathological tissues are come out, comprising step:
1. first drill bit or pin are passed the place of safety that joint capsule or loose skeleton enter spinal canal, described spinal canal is positioned at the side of neural bar (cerebral dura mater) and at the center of branch and excitor nerve root, may enter pathological tissues, for example intervertebral disk hernia part, little joint or skeleton capsule hypertrophy, synovial cyst or tumor.
2. successfully insert surgical drill 1, described surgical drill 1 has the stubbed non-cutting protection end 12 of 5-15 millimeter and the rotation cut end 11 that the non-cutting protection of distance is held 10 to 15 millimeters, at the big 1-2 millimeter of cut place diameter.Along the passage that rotation for the first time gets out, the diameter of the cutting part 11 of surgical drill 1 increases gradually.
3. the skin openings that sees through the 6-11 millimeter of drill bit subsequently penetrates the waist muscle of back slow, by protective sleeve cartridge type intubate, rests on the bone edges of small joints in lumbar spine and periosteum.Based on the needed size of open back, may between the 6-12 millimeter, change, place the work intubate of corresponding size.By this intubate, can insert various spinal endoscopes and apparatus.Recognize that method of the present invention does not adopt the cut end of reamer formula at drill bit one end that removes tissue, and drill bit has the dull face protection portion of at least 5 millimeters long, avoid cutting or injury spinal nerve or cerebral dura mater.
This device makes the safety that becomes that removes of hypertrophied joint capsule and contiguous loose ligamenta flava thereof, and little joint skeleton hypertrophy removes the safety that also becomes, particularly when spinal canal stenosis.Based on the scope of pathological changes, can produce opening until 12 millimeters.Can carry out from a side, if desired, also can carry out from both sides.There is the bilateral narrow latter that adopts when maybe needing to insert a cage shape thing in the vertebra.Owing to can not touch spinal nerve significantly during the course, thereby can under local anesthesia, carry out.
In a preferred embodiment, finish the posterolateral opening of spinal canal by specification 18 spinal needle.After the posterolateral skin of anesthesia, be 60 degree in angle, apart from the centrage 10-14 centimeters of spinal column, under the imaging of X-ray booster, carry out aforesaid operations, directly the intraspinal diseased region of alignment ridge.In case spinal needle is run into skeletal structure, remove the trocar of spinal needle, insert guide wire.By this guide wire, the expanding bar that will have conical tip is inserted into skeletal structure, with the expansion soft tissue.Insert and remove 3 millimeters convergent divergent channel subsequently.Insert 3 millimeters convergent divergent channel subsequently, as first guide instrument with 2 millimeters internal diameters and handle.
Next, remove guide wire, put into the hand-held brill of full-length.First guide instrument is to be used for will boring under the help of two-dimentional booster imaging the direction of aiming at pathological structure.Drilling into the place of safety then, is 2 millimeters guiding channel up to running into pathologic structure and producing 1-2 centimeter length, diameter.Remove brill subsequently and substitute it with guide wire.Adopt guide wire to produce expanding channel with work intubate necessary diameter.To skeleton, insert first surgical drill with dull face protection portion of 0.5-1.0 centimeter length of the present invention at soft-tissue expansion.The diameter of the protection portion of surgical drill is 2 millimeters, and the diameter of cutting part is 3 millimeters.Adopt surgical drill, intraspinal opening expands 3 millimeters to.Then remove this special drill bit, and insert guide wire.Subsequently, put into a brill with dull face protection portion and cutting part, the diameter of protection portion is 3 millimeters, and the diameter of cutting part is 4 millimeters.Then increase the diameter of drill bit and repeat these steps.This drill bit group comprises a plurality of drill bits of a plurality of diameters with 1 millimeter increase.Under such mode, the opening of spinal canal can reach 12 millimeters.When opening reaches the channel diameter that needs, insert the corresponding work intubate, thereby spinal endoscope and apparatus can be stretched in the intubate.
In order to control operative procedure and to aim at operating theater instruments exactly, can under the imaging of X-ray booster or other imaging devices that is fit to, carry out following several steps, insert first pin to open first passage by tissue, stretch into Yamshidi pin and adjusting angle and produce guide opening (introducing a pilothole), in the degree of depth of guiding channel boring and keyhole.After these steps, the behavior of boring and follow-up surgical work just can controllably be carried out under the imaging of X-ray booster or other imaging devices that is fit to.
Figure 10 and 11 shows the drill bit group in the another embodiment of the present invention.Specifically, Figure 10 a and 10b illustrate first drill bit in the drill bit group, and Figure 11 a and 11b illustrate second surgical drill in the drill bit group.
Surgical drill 1 among Figure 10 a and the 10b " the first overall diameter d ' 1 of cutting part 11 ' be 4 millimeters.The diameter d l of non-in this embodiment cutting protection end 12 ' is 2 millimeters.The axial length of cutting part 11 ' is 25 millimeters.
According to the embodiment shown in Figure 10 a and the 10b, non-cutting protection end 12 ' comprises a columnar portion 120 that is positioned at cutting part 11 ' far-end.Far-end in columnar portion 120 has a conus portion 122, at the far-end of conus portion one spherical portion 124 is arranged.In this embodiment, conus portion 122 is roughly taper shape.Spherical portion 124 is roughly semi-spherical shape, but also can be oval, parabola shaped or other any shapes that can further reduce non-cutting protection end to various soft tissues or neural influence.
As mentioned above, spherical portion 124 has further been improved the protective value of non-cutting protection end 12 ', and its smooth round edge can not cut off or damage nerve, tissue and/or cerebral dura mater.Conus portion 122 be used for convenient and safely with surgical drill 1 " be inserted into the hole of having bored in the skeleton and/or the pipeline that bored in.Columnar portion 120 is used for safely to surgical drill 1 " particularly drill member 10 is for the hole of having bored centering.
The far-end and the length L between the handle 15 at non-cutting protection end 12 ' of drill member 10 are about 200 millimeters.About 75 millimeters on handle 15 in horizontal expansion.
Surgical drill 1 ' shown in Figure 11 a and the 11b " with the surgical drill 1 shown in Figure 10 a and the 10b " structure basic identical.Specifically, drill member 10 also comprises cutting part 11 ' and non-cutting protection end 12 ', and wherein non-cutting protection end 12 ' comprises columnar portion 120, conus portion 122 and spherical portion 124 from the near-end to the far-end.The length L of drill member 10 is about 200 millimeters, and handle 15 is about 75 millimeters in the distance H of horizontal expansion.At the surgical drill shown in Figure 10 a and the 10b 1 " in, handle 15 is detachable handles, can pull down from drill member 10.
At the surgical drill shown in Figure 10 a and the 10b 1 " in, cutting part 11 ' is 25 millimeters in the length of axial direction.
Yet, in the embodiment shown in Figure 11 a and the 11b, surgical drill 1 ' " diameter with at the surgical drill 1 shown in Figure 10 a and the 10b " diameter different.Specifically, at surgical drill 1 ' " embodiment in, the overall diameter d ' 2 of cutting part 11 ' is 6 millimeters, but not the overall diameter d2 of cutting protection end 12 ' is 4 millimeters.
Therefore, the surgical drill 1 ' shown in Figure 11 a and the 11b " non-cutting protection end 12 ' can be inserted into by the surgical drill 1 shown in Figure 10 a and the 10b " in the hole or passage that get out in advance.Next, the surgical drill 1 ' shown in Figure 11 a and the 11b " for by surgical drill 1 " bore good hole and/or passage and feel relieved exactly.
Figure 12 shows surgical drill 1 among Figure 10 a, 10b, 11a and the 11b " and 1 ' " the vertical view of handle 15.Specifically, locking mechanism 150 makes the surgeon detachable handle 15 can be locked on the drill member 10.
In addition, at the center of drill member 10, be useful on the guiding channel 14 that inserts guide wire.Surgical drill 1 shown in Figure 10 a and the 10b " and Figure 11 a and 11b shown in surgical drill 1 ' " comprise all that from the instruct passage of far-end described guiding channel 14 is used for guide wire being inserted and passing drill member 10 from far-end to near-end to proximal extension.The interior diameter of the guiding channel 14 of all surgical drills is basic identical in the present embodiment.
Therefore; embodiment shown in Figure 10 a, 10b, 11a and the 11b has provided a kind of surgical drill group; described surgical drill group comprises at least two surgical drills 1 " and 1 ' "; the overall diameter d ' 1 of their cutting part 11 ' is different with d ' 2, and the overall diameter d1 of non-cutting protection end 12 ' is also different with d2.

Claims (44)

1, a kind of surgical drill (1; 1 '); comprise drill member (10); described drill member (10) has the cutting part that is used for cutting bone (11,11 ', 11 "); described cutting part is in the far-end of described drill member; wherein, and described drill member has the not cut non-cutting protection end of the neuroprotective of being used for, tissue and/or cerebral dura mater (12), and described non-cutting protection end is positioned at the end of described cutting part.
2. surgical drill according to claim 1, wherein, described cutting part has first overall diameter (d '), and described non-cutting protection end has second overall diameter (d), and described second overall diameter (d) is less than first overall diameter of described cutting part.
3. surgical drill according to claim 2, wherein, described non-cutting protection end has second overall diameter (d), and described second overall diameter (d) is littler 1 millimeter to 2 millimeters than first overall diameter of described cutting part.
4. according to the described surgical drill of aforementioned each claim, wherein, described non-cutting protection end comprises at least one columnar portion (120) haply and the conus portion (122) that at least one is positioned at the far-end of described columnar portion haply.
5. surgical drill according to claim 4, wherein, described non-cutting protection end comprises the spherical portion haply (124) of the far-end that at least one is positioned at described conus portion haply.
6. according to the described surgical drill of aforementioned each claim, wherein, described non-cutting protection end is dull face.
7. surgical drill according to claim 6, wherein, described non-cutting protects end to comprise at least one through polishing and/or slick surface portion, especially through the surface portion of machine glazed finish and/or the surface portion of process electropolishing.
8. according to the described surgical drill of aforementioned each claim, wherein, described non-cutting protection end is covered with the level and smooth coating of slick coating, especially quality, low-friction coating and/or polytetrafluorethylecoatings coatings.
9. according to the described surgical drill of aforementioned each claim, wherein, described non-cutting protection end is at least 5 millimeters in the length (l) of distal direction, is preferably between 5 millimeters and 15 millimeters preferably 5 millimeters or 10 millimeters or 15 millimeters.
10. according to the described surgical drill of aforementioned each claim, wherein, described cutting part has and the contiguous cutting end face (110) of described non-cutting protection end.
11. according to the described surgical drill of aforementioned each claim, wherein, also comprise the sleeve (2) with sleeve passage (20), described sleeve passage (20) is used to hold described drill member (10), can rotate when making described drill member (10) insert described sleeve.
12. surgical drill according to claim 11, wherein, described sleeve has female thread (222) at its near-end, and described drill member has external screw thread (122) at its near-end, so that described drill member can be by drill member and described telescopic relative rotation, and advances with respect to described sleeve.
13. according to the described surgical drill of aforementioned each claim, wherein, described drill member comprises the axially extended guiding channel (13) along described drill member, so that guide wire (4 ') can pass described drill member and insert in the described guiding channel.
14. surgical drill according to claim 13, wherein, described guiding channel is from the far-end of the described drill member proximal extension to described drill member.
15. according to the described surgical drill of aforementioned each claim, wherein, described cutting part is at least a in stiletto, trepan, milling cutter, reamer or the trepan (11,11 ").
16. according to the described surgical drill of aforementioned each claim, wherein, described cutting part has drill bit screw thread (11 ').
17., wherein, handle (15), detachable handle are arranged and/or are connected to the adapter of power auger at the near-end of described drill member according to the described surgical drill of aforementioned each claim.
18. surgical drill group; at least comprise described one first surgical drill of each claim and one second surgical drill as described above, the overall diameter of the cutting part of described first surgical drill (11) is equal to or greater than the overall diameter of the non-cutting protection end (12) of described second surgical drill.
19. surgical drill group according to claim 18, wherein, the hole that the diameter of the described non-cutting protection end of described second surgical drill gets out its cutting part that can insert described first surgical drill.
20. according to claim 18 or 19 described surgical drill groups, wherein, described surgical drill group is provided with a plurality of surgical drills, the diameter of the cutting part of described a plurality of drill bits (d ') be respectively 3 millimeters, 4 millimeters, 5 millimeters, 6 millimeters, 7 millimeters, 8 millimeters, 9 millimeters, 10 millimeters, 11 millimeters and 12 millimeters, or be respectively 3.5 millimeters, 4.5 millimeters, 5.5 millimeters, 6.5 millimeters, 7.5 millimeters, 8.5 millimeters, 9.5 millimeters, 10.5 millimeters, 11.5 millimeters and 12.5 millimeters.
21. according to claim 18 or 19 described surgical drill groups; wherein; described surgical drill group is provided with a plurality of surgical drills; the diameter of the cutting part of described a plurality of drill bits (d ') be respectively 4 millimeters, 6 millimeters, 8 millimeters and 10 millimeters, the diameter of corresponding described non-cutting protection end is respectively 2 millimeters, 4 millimeters, 6 millimeters and 8 millimeters.
22. according to any described surgical drill group of claim 18-21, wherein, the length (l) of the described non-cutting protection end of all surgical drills all equates.
23. according to any described surgical drill group of claim 18-22, wherein, described surgical drill has sleeve, each after the sleeve of surgical drill can both be placed on respectively on the sleeve of surgical drill the preceding.
24. a surgical drill comprises drill member, described drill member has:
Cutting part is used for cutting bone, and described cutting part is in the far-end of described drill member;
Non-cutting protection end is used for neuroprotective, tissue and/or cerebral dura mater and is not cut off, and described non-cutting protection end is positioned at the far-end of described cutting part;
Described cutting part has first overall diameter, and described non-cutting protection end has second overall diameter less than described first overall diameter of described cutting part.
25. surgical drill according to claim 24, it comprises among the claim 3-17 feature of at least one.
26. a surgical drill comprises drill member, described drill member has:
Cutting part is used for cutting bone, and described cutting part is in the far-end of described drill member;
Non-cutting protection end is used for neuroprotective, tissue and/or cerebral dura mater and is not cut off, and described non-cutting protection end is positioned at the far-end of described cutting part;
Guiding channel, described passage extends axially along described drill member, so that guide wire can pass described drill member and insert described guiding channel.
27. surgical drill according to claim 26, wherein, described guiding channel is from the far-end of the described drill member proximal extension to described drill member.
28. according to claim 26 or 27 described surgical drills, it comprises at least one feature of claim 2-12 and/or 15-17.
29. the system of a cutting bone, described system comprise that at least one is as the described surgical drill of one of claim 1-17 and a work intubate (9) of inserting health.
30. system according to claim 29, wherein, described system also comprises the pin (3) with trocar, and the pin of specification 18 preferably is used to locate the guide opening of health skeleton and passes the hole of described pin and the guide wire (4) that inserts.
31. according to claim 29 or 30 described systems, wherein, described system comprises expanding bar (5), is used for the passage of expansion body inner tissue.
32. according to the described system of one of claim 29-31, wherein, described system also comprises having the Yamshidi pin, and described Yamshidi pin comprises Yamshidi sleeve (7), is used for producing the Yamshidi trocar of guide opening and being used to insert the telescopic drill bit of Yamshidi (8) at skeleton.
33. according to the described system of one of claim 29-32, wherein, described system comprises arbitrary described surgical drill group as claim 18-23.
34. a method that removes skeleton may further comprise the steps:
The guiding channel (650) that a. will have initial diameter is introduced skeleton;
The surgical drill (1) that b. will comprise cutting element (11) stretches into described guiding channel, the cutting diameter of described cutting element is greater than described initial diameter, described surgical drill has the non-cutting protection end (12) that diameter is equal to or less than described initial diameter at its far-end, before boring, described non-cutting protection end is inserted described guiding channel;
C. the surgical drill that a series of cutting diameters are increased gradually stretches into the passage (651) that previous surgical drill produces respectively; because the diameter that corresponding described non-cutting protection is held is equal to or less than the cutting diameter of described previous surgical drill, in the passage of therefore described non-cutting protection end insertion by the cutting part generation of corresponding previous surgical drill.
35. method according to claim 34, wherein, guiding channel passes the place of safety of each skeleton, and is especially tangent with the skeleton pipe, as tangent with spinal canal.
36. according to claim 34 or 35 described methods, wherein, by making first drill bit, especially the Yamshidi sleeve (7) by the Yamshidi pin, pass joint capsule or loose skeleton enter neural bar (cerebral dura mater) side and produce guiding channel in the place of safety of the spinal canal at the center of branch and excitor nerve root.
37. according to the described method of one of claim 34-36, wherein, drill bit enters the tissue of pathological changes, for example intervertebral disk hernia part, little joint or skeleton capsule hypertrophy, synovial cyst or tumor.
38. according to the described method of one of claim 34-37; wherein; surgical drill passes described guiding channel and advances; described surgical drill has non-cutting protection end and is 10 millimeters to 15 millimeters cutting part to the distance of described protection portion distal-most end, and the diameter that the overall diameter of described cutting part is held than described non-cutting protection is big 1 millimeter to 2 millimeters.
39. according to the described method of one of claim 34-38, wherein, guide wire extend into described guiding channel, the apparatus of Shi Yonging is guided by described guide wire subsequently.
40., also comprise following steps: described guide wire is inserted in the axially extended guiding channel of described surgical drill according to the described method of claim 39.
41. according to the described method of one of claim 34-40, wherein, before guiding channel in skeleton produces, be used to open the pin of first passage, 18 gage needle are preferably passed the tissue around the skeleton and are advanced.
42. according to the described method of claim 41, wherein, guide wire extend in the passage of being opened by described pin.
43. according to claim 41 or 42 described methods, wherein, expanding bar (5) is passed and is expanded described passage in the passage of being opened by described pin.
44., wherein, sleeve (2) is stretched into the passage that process is expanded, for advancing of first surgical drill provides passage according to the described method of claim 43.
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US20070093841A1 (en) 2007-04-26
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WO2007039141A3 (en) 2007-08-09
ATE506898T1 (en) 2011-05-15

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Denomination of invention: A surgical drill, a set of surgical drills, a system for cutting bone and a method for removing bone

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Conclusion of examination: On the basis of the amended claims proposed by the patentee on February 9, 2018, the technical solutions of No. 200680034944.4 invention patent claims 3 to 5, 16 to 17, 23 to 28, and claims 6 to 15, 19 to 22 directly or indirectly referring to claim 3, as well as all the technical solutions including the additional technical features in claims 3, 4 and 16 in claims 29 to 33 are valid, The technical solutions claimed in other claims are declared invalid.

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